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Background: Ophthalmic procedures are increasingly being performed under regional anesthesia techniques such as peribulbar and incisionless sub-Tenon's blocks. The aim is to compare peribulbar block with incisionless sub-Tenon's block in terms of perioperative complications in patients who underwent cataract and vitreoretinal surgeries. Methods: The patients who underwent cataract or vitroretinal surgery under peribulbar block or incisionless sub-Tenon's block were included in the study. Two groups were compared each other in terms of anesthesia-related complications. Results: A total of 125 patients [peribulbar block (N = 48) and incisionless sub-Tenon's block (N = 77)] were included in the study. All basic characteristics and perioperative hemodynamic parameters were similar between the groups. One (0.8%) patient in the peribulbar block developed retrobulbar hemorrhage, whereas there was no major complication in the incisionless sub-Tenon's group (P = 0.389). At 15th minutes after block and at the end of the operation, minor complications including chemosis and subconjunctival hemorrhage were observed significantly lower in the peribulbar block group in comparison to the incisionless sub-Tenon's block group (P < 0.05). Conclusions: Minor complications including subconjunctival haemorrhage and chemosis were more common in the incisionless sub-Tenon's block; however, this difference was statistically balanced on the first postoperative day. One patient in the peribulbar block developed retrobulbar hemorrhage, whereas there was no major complication in the incisionless sub-Tenon's block. According to those results, incisionless sub-Tenon's block seems to be a safe and reliable alternative for ophthalmic procedures. [ABSTRACT FROM AUTHOR]

Background: We report a case of brainstem anesthesia (BSA) and subsequent cardiac arrest following a routinary peribulbar block (PB) in a patient scheduled for cataract extraction and intraocular lens (IOL) implantation, thus providing a reference for further analysis of this potentially catastrophic life-threatening complication and to evaluate the current knowledge in terms of incidence, physiopathology management, and treatment of the BSA following PB. Methods: Three databases (PubMed, Embase, and Scopus) were checked to perform a systematic review of all available studies in the English Language following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate relevant studies that clearly described BSA following BSA. Results: Our literature search identified 15 cases. All the patients experienced BSA-related symptoms, including respiratory arrest, seizure, heart rate, and blood pressure abnormalities. All the patients with respiratory arrest required assisted ventilation with intubation, whereas patients with seizures were administered intravenous midazolam. Only one patient experienced cardiac arrest and underwent cardiac resuscitation. Surgery was aborted and deferred in 5 out of 15 patients, whereas 4 out of 15 underwent surgery after extubation. Conclusions: Despite the BSA incidence after the PB being very low, this possible life-threatening rare event should be considered in patients losing their consciousness and becoming apneic after the block. Therefore, prompt recognition and immediate treatment are paramount to cope with this potentially catastrophic scenario and save the patient's life. [ABSTRACT FROM AUTHOR]

Objectives: Opioid-minimizing strategies are making their appearance in enhanced recovery after surgery. This study is aimed to explore the potential advantages of opioid-free analgesia (OFA) compared to opioid-sparing analgesia (OSA) in patients undergoing orbital fracture reconstruction. Methods: In this prospective, single-center, randomized controlled study, we randomly recruited 122 patients undergoing orbital fracture reconstruction under general anesthesia. Patients received total intravenous anesthesia with a flexible laryngeal mask airway, and multimodal analgesia with either OSA or OFA methods. The OSA group (n = 61) received low doses of fentanyl and nonsteroidal anti-inflammatory drugs (NSAIDs), and the OFA group (n = 61) received medial canthus peribulbar block (MCPB) combined with NSAIDs. The primary outcomes consisted of area-under-the-curve (AUC) of the numerical rating scale (NRS) pain score, and the incidence of postoperative nausea and vomiting (PONV) through the first 24h. Results: Compared to the OSA group, the OFA group demonstrated non-inferiority in postoperative analgesia through the first 24 postoperative hours (difference of the medians, − 6; 95% confidence interval [CI], − 12 to 6), but failed to meet the non-inferiority criterion in the incidence of PONV (difference ratio, 3%; 95% CI, − 7% to 14%). The Quality of Recovery-40 questionnaire (QoR-40) scores on postoperative day 1 was significantly higher in group OFA compared to group OSA (188 [178 to 196] vs 181 [169 to 191], respectively; P = 0.005). Conclusion: In orbital fracture reconstruction, both OFA and OSA strategies provide effective postoperative pain relief, but OFA using MCPB combined NSAIDs enhances the quality of early postoperative recovery. Registered: Chinese Clinical Trial Registry ChiCTR1900028088. [ABSTRACT FROM AUTHOR]

Background/Objectives: Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinociception and avoid the possibility of intolerable postoperative pain perception (IPPP). Adequacy of anesthesia guidance (AoA) optimizes the titration of IROA. Preventive analgesia (PA) techniques and intravenous or preoperative peribulbar block (PBB) using different local anesthetics (LAs) are performed prior to GA to optimize IROA. The aim was to analyze the utility of PBBs compared with intravenous paracetamol added to AoA-guided GA on the incidence of IPPP and hemodynamic stability in patients undergoing VRS. Methods: A total of 185 patients undergoing vitreoretinal surgery (VRS) were randomly assigned to one of several anesthesia protocols: general anesthesia (GA) with analgesia optimized through AoA-guided intraoperative remifentanil opioid analgesia (IROA) combined with a preemptive single dose of 1 g of paracetamol (P group), or PBB using one of the following options: 7 mL of an equal mixture of 2% lidocaine and 0.5% bupivacaine (BL group), 7 mL of 0.5% bupivacaine (BPV group), or 7 mL of 0.75% ropivacaine (RPV group). According to the PA used, the primary outcome measure was postoperative pain perception assessed using the numeric pain rating scale (NPRS), whereas the secondary outcome measures were as follows: demand for IROA and values of hemodynamic parameters reflecting quality or analgesia and hemodynamic stability. Results: A total of 175 patients were finally analyzed. No studied PA technique proved superior in terms of rate of incidence of IPPP, when IROA under AoA was administered (p = 0.22). PBB using ropivacaine resulted in an intraoperative reduction in the number of patients requiring IROA (p = 0.002; p < 0.05) with no influence on the dose of IROA (p = 0.97), compared to paracetamol, and little influence on hemodynamic stability of no clinical relevance in patients undergoing VRS under AoA-guided GA. Conclusions: PA using paracetamol or PBBs, regardless of LAs used, in patients undergoing VRS proved no advantage in terms of rate of incidence of IPPP and hemodynamic stability when AoA guidance for IROA administration during GA was utilized. Therefore, PA using them seems no longer justified due to the potential, although rare, side effects. [ABSTRACT FROM AUTHOR]

Background: Local anaesthesia is most commonly used for cataract surgery in adult patients. Different combinations of local anesthetic agents and adjuvants have been used to provide adequate anaesthesia and analgesia. This study assessed the effect of adding 25 µg fentanyl to lidocaine with adrenaline mixture on the onset and duration of anaesthesia in adult patients undergoing cataract surgery under peribulbar anaesthesia. Methods: This was a double blind, randomized controlled study. Adult patients aged 40 years and above with American Society of Anesthesiologists Physical Status Classes 1 and 2 undergoing cataract surgery under peribulbar block (PB) were studied. Sixty-six patients were randomized into two equal groups. Group A had 25 µg fentanyl (0.5 mL) added to 6 mL of 2% lidocaine with adrenaline while Group B had sterile water 0.5 mL added to 6 mL of 2% lidocaine with adrenaline for PB. Onset and duration of lid akinesia, globe akinesia, globe anaesthesia, Numerical Rating Scale (NRS) pain score, time to analgesia request as well as patient and surgeon satisfaction were assessed. Results: The differences in the onset of lid akinesia, globe akinesia, and globe anaesthesia between the two groups were statistically significant (P ≤ 0.001, respectively). The mean duration of globe akinesia and globe anaesthesia was longer in Group A as compared to Group B (P = 0.008 and P = 0.009, respectively). Statistically significant differences in median NRS scores were found at the 4th, 5th, and 6th h (P = 0.001, respectively). The mean duration to analgesia request was 238.1 ± 65.5 min in Group A compared to 207.2 ± 49.1 min in Group B (P = 0.034). Conclusion: The addition of 25 µg fentanyl to 2% lidocaine plus adrenaline mixture improved the quality of peribulbar anaesthesia and is recommended in Nigerian adults scheduled for cataract surgery under peribulbar anaesthesia to improve their surgical experience.

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Background: For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia. Aims and Objective: This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion. Material and Methods: Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment. Results: Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P>0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P>0.05). (P>0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05). Conclusion: Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine.

Background: Local anaesthesia is most commonly used for cataract surgery in adult patients. Different combinations of local anesthetic agents and adjuvants have been used to provide adequate anaesthesia and analgesia. This study assessed the effect of adding 25 µg fentanyl to lidocaine with adrenaline mixture on the onset and duration of anaesthesia in adult patients undergoing cataract surgery under peribulbar anaesthesia. Methods: This was a double blind, randomized controlled study. Adult patients aged 40 years and above with American Society of Anesthesiologists Physical Status Classes 1 and 2 undergoing cataract surgery under peribulbar block (PB) were studied. Sixty‑six patients were randomized into two equal groups. Group A had 25 µg fentanyl (0.5 mL) added to 6 mL of 2% lidocaine with adrenaline while Group B had sterile water 0.5 mL added to 6 mL of 2% lidocaine with adrenaline for PB. Onset and duration of lid akinesia, globe akinesia, globe anaesthesia, Numerical Rating Scale (NRS) pain score, time to analgesia request as well as patient and surgeon satisfaction were assessed. Results: The differences in the onset of lid akinesia, globe akinesia, and globe anaesthesia between the two groups were statistically significant(P ≤ 0.001,respectively).Themeanduration of globe akinesia and globe anaesthesia was longer in GroupA as compared to GroupB (P = 0.008 and P = 0.009, respectively). Statistically significant differences in median NRS scores were found at the 4th, 5th, and 6th h (P = 0.001, respectively). The mean duration to analgesia request was 238.1 ± 65.5 min in Group A compared to 207.2 ± 49.1 min in Group B (P = 0.034). Conclusion: The addition of 25 µg fentanyl to 2% lidocaine plus adrenaline mixture improved the quality of peribulbar anaesthesia and is recommended in Nigerian adults scheduled for cataract surgery under peribulbar anaesthesia to improve their surgical experience. [ABSTRACT FROM AUTHOR]

Background: For intraocular surgery, the optimal local anesthetic agent must have a rapid onset of action and a sufficient duration of effect so as to enable a painless, motionless procedure without prolonging akinesia. Aims and Objective: This prospective, comparative observational study compares ropivacaine and 0.5% bupivacaine for cataract surgery peribulbar block. Hyaluronidase is utilized in both groups because it promotes local anesthetic diffusion. Material and Methods: Present prospective, observational, comparative study performed at the Department of Anesthesia Tertiary Care Teaching Institute of India for the duration of 1 year. All eligible patients were allocated in two groups as GROUP B and GROUP R. GROUP B: 10 mL of 0.5% bupivacaine and 15 I.U./mL of hyaluronidase. GROUP R: 10 mL of 0.5% ropivacaine and 15 I.U./mL of hyaluronidase. Patients were assessed for sensory block, eyelid, and ocular movements at an interval of 2 min, and Visual Analog Scale score for pain assessment. Results: Age and gender did not differ significantly between the two study groups, according to the findings. Comparable and similar patient characteristics distinguished the two study groups. (P>0.05). The difference in onset of eyelid motor blockade between the two groups was not statistically significant. The difference in the onset of motor blockade [ocular movement] between the two groups was not statistically significant (P>0.05). (P>0.05) Analgesia duration differed significantly between the two groups in a statistical sense. Ropivacaine exhibits a significantly prolonged duration of analgesic effect than bupivacaine (P≤0.05). Conclusion: Peribulbar block utilizing 0.5% ropivacaine is a more favorable and secure option for a local anesthetic that effectively extends postoperative pain alleviation, in comparison to the use of 0.5% bupivacaine. [ABSTRACT FROM AUTHOR]

Introduction: Regional anesthesia is a better alternative whenever general anesthesia is undesirable or contraindicated. Peribulbar block is considered preferable over retrobulbar block in achieving anesthesia for intraocular and extraocular surgeries. It is widely used because it is easier to perform. Objectives: This study compares the efficacy of levobupivacaine over lignocaine for peribulbar anesthesia in cataract surgery. Methods: A prospective, randomized double-blinded study comparing levobupivacaine for peribulbar anesthesia in cataract surgery was done with 30 patients in each group. Included patients were randomly categorized into Group 1 and Group 2. Group 1 received lignocaine with adrenaline and Group 2 received 0.5% levobupivacaine with main outcome variables of the study intraoperative and postoperative pain, motor sensory onset, akinesia score, and analgesia duration. Results: In both the groups, there was no significant difference in terms of age and gender. There was statistical significance between the two groups in terms of motor blockade. There is a significant mean difference between Group 1 and Group 2 when compared with akinesia score with P < 0.05. The pain was less in Group 2 than Group 1. There is no significant difference in both when compared with verbal pain score. Heart rate and blood pressure showed a difference. Conclusion: Topical anesthesia with levobupivacaine was more effective than lignocaine surgeries with better analgesia and lesser complication.

ABSTRACTBackground Adding certain drugs to the local anesthetics (LA) in peribulbar block (PBB) increases its intensity and duration of action, so we did this research to assess the impact of fentanyl addition to the LA in PBB for vitrectomy.Methods Forty patients were divided into:Control group: They got 9.5 ml of 0.5% bupivacaine (6 ml), 2% lidocaine (1.5 ml), 45 IU hyaluronidase (in 1.5 ml lidocaine), and 0.5 ml saline.Fentanyl group: They got the same medications plus 0.5 ml (25 mcg) of fentanyl instead of the saline.Our primary outcome was the duration of the block, and our secondary outcomes were the start of the motor block, scores for globe and lid akinesia, the quality of the block, scores for patient and surgeon satisfaction, postoperative VAPS, and the first request for analgesia and complications from the drugs used or the technique.Results The start of the motor block was significantly rapid in the fentanyl group. Additionally, there were notable variations in the length and intensity of the block between the two groups. The postoperative pain score was lower in the fentanyl group. While it was acceptable in the control group, the block quality was perfect in the fentanyl group. Complete patient satisfaction happens more often in the fentanyl group. There were no complications reported.Conclusion Fentanyl, when added to LA mixtures in PBB in vitrectomy, decreased the onset, increased the duration of lid and globe akinesia, and improved the quality of analgesia without causing any complications.

Background/Objectives: Precisely selected patients require vitreoretinal surgeries (VRS) performed under general anesthesia (GA) when intravenous rescue opioid analgesics (IROA) are administered intraoperatively, despite a risk of adverse events, to achieve hemodynamic stability and proper antinociception and avoid the possibility of intolerable postoperative pain perception (IPPP). Adequacy of anesthesia guidance (AoA) optimizes the titration of IROA. Preventive analgesia (PA) techniques and intravenous or preoperative peribulbar block (PBB) using different local anesthetics (LAs) are performed prior to GA to optimize IROA. The aim was to analyze the utility of PBBs compared with intravenous paracetamol added to AoA-guided GA on the incidence of IPPP and hemodynamic stability in patients undergoing VRS. Methods: A total of 185 patients undergoing vitreoretinal surgery (VRS) were randomly assigned to one of several anesthesia protocols: general anesthesia (GA) with analgesia optimized through AoA-guided intraoperative remifentanil opioid analgesia (IROA) combined with a preemptive single dose of 1 g of paracetamol (P group), or PBB using one of the following options: 7 mL of an equal mixture of 2% lidocaine and 0.5% bupivacaine (BL group), 7 mL of 0.5% bupivacaine (BPV group), or 7 mL of 0.75% ropivacaine (RPV group). According to the PA used, the primary outcome measure was postoperative pain perception assessed using the numeric pain rating scale (NPRS), whereas the secondary outcome measures were as follows: demand for IROA and values of hemodynamic parameters reflecting quality or analgesia and hemodynamic stability. Results: A total of 175 patients were finally analyzed. No studied PA technique proved superior in terms of rate of incidence of IPPP, when IROA under AoA was administered (p = 0.22). PBB using ropivacaine resulted in an intraoperative reduction in the number of patients requiring IROA (p = 0.002; p < 0.05) with no influence on the dose of IROA (p = 0.97), compared to paracetamol, and little influence on hemodynamic stability of no clinical relevance in patients undergoing VRS under AoA-guided GA. Conclusions: PA using paracetamol or PBBs, regardless of LAs used, in patients undergoing VRS proved no advantage in terms of rate of incidence of IPPP and hemodynamic stability when AoA guidance for IROA administration during GA was utilized. Therefore, PA using them seems no longer justified due to the potential, although rare, side effects.

Background & Objective: Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, the prolonged onset of orbital akinesia and the frequent need for block replenishment are considered drawbacks. We aimed to investigate the impact of adding rocuronium and magnesium sulfate to a commonly used local anesthetic combination on the onset of corneal anesthesia and the degree of lid and globe akinesia during peribulbar block in ocular surgeries. Patients and Methods: This prospective double-blinded randomized study was conducted in the ophthalmic surgery operating theater, Ain Shams University Hospital from January 2019 to April 2020. We enrolled 75 patients from both sexes, with American Society of Anesthesiology (ASA) physical status I-III, ages 40-80 y, and an axial globe length less than or equal to 26 mm planned for cataract surgery under peribulbar block in the study following institutional ethical board approval and written informed patient consents. Patients were randomly divided into three groups, 25 patients per group, based on the drugs they received: Group O (control group): received local anesthetic + 0.9% normal saline (1 ml). Group M: received local anesthetic + magnesium sulphate 50 mg in normal saline. Group R: received local anesthetic + rocuronium at a dose of 0.06 mg/kg (maximum 5 mg) in normal saline. Results: Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00 ± 1.22 min) than control group and magnesium sulfate group (9.00 ± 1.47 and 9.00 ± 1.15 min) respectively, (P < 0.001); Moreover, no significant difference was noted between control group and magnesium sulfate group. In addition, no relevant difference was reported regarding duration of surgery between the groups. Conclusion: During cataract surgery, the addition of rocuronium to the local anesthetic mixture in the peribulbar nerve block has been found to enhance ocular akinesia and corneal anesthesia. Furthermore, the use of rocuronium demonstrated a significantly faster onset and shorter time needed to achieve the appropriate conditions to initiate the surgical procedure compared to the use of magnesium sulfate. Addition of magnesium sulfate showed good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery. [ABSTRACT FROM AUTHOR]

Introduction: Regional anesthesia is a better alternative whenever general anesthesia is undesirable or contraindicated. Peribulbar block is considered preferable over retrobulbar block in achieving anesthesia for intraocular and extraocular surgeries. It is widely used because it is easier to perform. Objectives: This study compares the efficacy of levobupivacaine over lignocaine for peribulbar anesthesia in cataract surgery. Methods: A prospective, randomized double-blinded study comparing levobupivacaine for peribulbar anesthesia in cataract surgery was done with 30 patients in each group. Included patients were randomly categorized into Group 1 and Group 2. Group 1 received lignocaine with adrenaline and Group 2 received 0.5% levobupivacaine with main outcome variables of the study intraoperative and postoperative pain, motor sensory onset, akinesia score, and analgesia duration. Results: In both the groups, there was no significant difference in terms of age and gender. There was statistical significance between the two groups in terms of motor blockade. There is a significant mean difference between Group 1 and Group 2 when compared with akinesia score with P < 0.05. The pain was less in Group 2 than Group 1. There is no significant difference in both when compared with verbal pain score. Heart rate and blood pressure showed a difference. Conclusion: Topical anesthesia with levobupivacaine was more effective than lignocaine surgeries with better analgesia and lesser complication. [ABSTRACT FROM AUTHOR]

Introduction: Regional anesthesia is a better alternative whenever general anesthesia is undesirable or contraindicated. Peribulbar block is considered preferable over retrobulbar block in achieving anesthesia for intraocular and extraocular surgeries. It is widely used because it is easier to perform. Objectives: This study compares the efficacy of levobupivacaine over lignocaine for peribulbar anesthesia in cataract surgery. Methods: A prospective, randomized double-blinded study comparing levobupivacaine for peribulbar anesthesia in cataract surgery was done with 30 patients in each group. Included patients were randomly categorized into Group 1 and Group 2. Group 1 received lignocaine with adrenaline and Group 2 received 0.5% levobupivacaine with main outcome variables of the study intraoperative and postoperative pain, motor sensory onset, akinesia score, and analgesia duration. Results: In both the groups, there was no significant difference in terms of age and gender. There was statistical significance between the two groups in terms of motor blockade. There is a significant mean difference between Group 1 and Group 2 when compared with akinesia score with P < 0.05. The pain was less in Group 2 than Group 1. There is no significant difference in both when compared with verbal pain score. Heart rate and blood pressure showed a difference. Conclusion: Topical anesthesia with levobupivacaine was more effective than lignocaine surgeries with better analgesia and lesser complication. [ABSTRACT FROM AUTHOR]

Background: Adding certain drugs to the local anesthetics (LA) in peribulbar block (PBB) increases its intensity and duration of action, so we did this research to assess the impact of fentanyl addition to the LA in PBB for vitrectomy. Methods: Forty patients were divided into: Control group: They got 9.5 ml of 0.5% bupivacaine (6 ml), 2% lidocaine (1.5 ml), 45 IU hyaluronidase (in 1.5 ml lidocaine), and 0.5 ml saline. Fentanyl group: They got the same medications plus 0.5 ml (25 mcg) of fentanyl instead of the saline. Our primary outcome was the duration of the block, and our secondary outcomes were the start of the motor block, scores for globe and lid akinesia, the quality of the block, scores for patient and surgeon satisfaction, postoperative VAPS, and the first request for analgesia and complications from the drugs used or the technique. Results: The start of the motor block was significantly rapid in the fentanyl group. Additionally, there were notable variations in the length and intensity of the block between the two groups. The postoperative pain score was lower in the fentanyl group. While it was acceptable in the control group, the block quality was perfect in the fentanyl group. Complete patient satisfaction happens more often in the fentanyl group. There were no complications reported. Conclusion: Fentanyl, when added to LA mixtures in PBB in vitrectomy, decreased the onset, increased the duration of lid and globe akinesia, and improved the quality of analgesia without causing any complications. [ABSTRACT FROM AUTHOR]

Background: Peribulbar anesthesia had been developed as a safer, easier, and effective alternative to retrobulbar anesthesia that provides ocular akinesia and anesthesia. Objective: This study aimed to compare the efficacy of mepivacaine 3% - lidocaine 2% hyaluronidase mixture with that of bupivacaine 0.5% - lidocaine 2% - hyaluronidase to produce optimal operative and post-operative conditions in patients receiving single peribulbar injection for cataract surgery. Patients and Methods: In this randomized, double -blind study, 90 adult patients were assigned to one of two groups (M and B), each comprising 45 patients. Study participants received 6-8 ml combination of equal parts of either mepivacaine 3% (Group M) or bupivacaine 0.5% (Group B) both with lidocaine 2% and hyaluronidase 25 IU/ml. Akinesia was assessed with a 12-point scale at 2, 5, 10 and 15 min after injection. Onset of sensory block, time to start surgery, pain and requirement for supplemental injection were also assessed. Results: Group M showed better akinesia scores than Group B and the onset of globe akinesia and sensory block were significantly faster in Group M. The duration of globe and lid akinesia was longer in Group B (159.16 ± 5.71 min and 150.02 ± 4.42 min, respectively) than in Group M (142.89 ± 6.52 min and 135.69 ± 4.81 min, respectively) and this showed statistical significance (P < 0.001). The percentage of patients who required supplementary injection was significantly higher in Group B (7 patients) compared to that in Group M (2 patients). Conclusion: Using a mixture of mepivacaine and lidocaine gives perfect globe akinesia and quicker establishment of appropriate conditions to start cataract surgery and shortens the block onset time with faster recovery compared with the addition of bupivacaine to lidocaine in peribulbar anesthesia. [ABSTRACT FROM AUTHOR]

Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon's blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon's blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries.

Background and Aims: Bupivacaine and lidocaine mixtures are the commonly used local anesthetic drugs for the peribulbar blocks. Because of its safe anesthetic profile, ropivacaine is being investigated as an alternative agent. Several centers have evaluated the effect of the addition of an adjuvant like dexmedetomidine (DMT) to ropivacaine in enhancing the block characteristics. We proposed to evaluate the effect of the addition of DMT to ropivacaine versus a control group not having DMT as adjuvant. Material and Methods: A prospective, randomized comparative study was conducted on a total of 80 patients attending our hospital for cataract surgeries. Patients were allocated into four groups of 20 each (n = 20) and peribulbar blocks were given 6 mL of 0.75% ropivacaine in group R and 6 mL of 0.75% ropivacaine plus 10 μg, 15 μg, and 20 μg DMT, respectively, in groups RD1, RD2, and RD3. Results: When DMT was used as an adjunct to ropivacaine, there was a prolongation of the duration of the sensory block. Conclusion: In peribulbar blocks, 6 mL of ropivacaine 0.75% produces satisfactory block characteristics, and the addition of 10 μg, 15 μg, or 20 μg of DMT as an adjuvant to ropivacaine 0.75% had the effect of significantly prolonging the duration of the sensory block, which is directly proportional to the dose of DMT employed. However, 20 μg of DMT added as an adjuvant to ropivacaine 0.75% appears to be the optimal dose, as this anesthetic drug mixture provides maximum prolongation of the sensory block besides providing satisfactory operating conditions, acceptable sedation levels, and stable hemodynamic parameters.

Background This study aimed to assess the safety and efficacy of a neostigmine/ketorolac combination as an adjuvant to a low-dose local anesthetic mixture used for peribulbar block during vitrectomy surgeries.Methods This double-blinded, parallel-group, randomized trial enrolled 50 adult patients of both genders who were American Society of Anesthesiologists physical status I or II and were scheduled for vitrectomy surgeries under regional anesthesia. All patients underwent peribulbar block through a single medial canthus injection technique. In the neostigmine and ketorolac (NK) group, 25 patients received a combined mixture of neostigmine (300 μg) and ketorolac (4 mg/ml) as adjuvants to a mixture of lidocaine (2%, 2.5 ml) and bupivacaine (0.5%, 3.5 ml) containing 75 units of hyaluronidase. The control (C) group received 1.5 ml of normal saline instead of neostigmine/ketorolac. The primary outcomes were the onsets and durations of both sensory and motor blocks. Secondary outcomes included the time to first analgesic dose, hemodynamics, adverse effects, and patient’s and surgeon’s satisfaction.Results The onsets of sensory and motor blocks were significantly shorter in the NK group compared to the C group. A significantly longer anesthesia and akinesia duration were observed in the NK group in comparison to the C group. The meantime to the first analgesic dose showed a significant difference between the NK and C groups. The NK group had a higher rate of adverse effects than the C group, though not reaching statistical significance. Patients’ and surgeons’ satisfactions were significantly higher in the NK group than the C group.Conclusions In peribulbar anesthesia for vitrectomy surgery, adding neostigmine/ketorolac combination to a low-dose local anesthetic mixture was effective in reducing the onset and prolonging the duration of both sensory and motor block, and it was associated with higher safety and better patients’ and surgeons’ satisfaction.

Background This study aimed to evaluate safety and efficacy of magnesium sulphate as an adjuvant to peribulbar block at two different doses (75 and 100 mg) in reducing intraocular pressure (IOP) in obese patients undergoing glaucoma surgery. Methods Forty-six adult patients, American Society of Anesthesiologists status I–III, with body mass index of 30–55 kg/m2 undergoing glaucoma surgery under peribulbar block were enrolled during February, 2021. Patients were randomly assigned into two groups (1:1). Both groups received 4 ml of lidocaine 2%, 4 ml of bupivacaine 0.5%, and 1 ml of hyaluronidase (10IU of hyaluronidase/ml of lidocaine). Magnesium sulphate was added to this mixture either in a dose of 75 mg (group I) or 100 mg (group II). Primary outcomes included onset of globe and lid akinesia and IOP. Secondary outcomes included durations of analgesia and motor block, patients’ and surgeons’ satisfaction, and vital data. Results The mean onsets to globe and lid akinesia were significantly lower in group II compared to group I (2.7 vs. 4.2 min, p

Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon's blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon's blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries. [ABSTRACT FROM AUTHOR]

Introduction: Cataract surgery is performed under peribulbar or retrobulbar block. Majority of the patients posted for cataract have some form of medical diseases like diabetes, hypertension, angina, ischaemic heart disease etc. Lidocaine and bupivacaine are the most commonly used local anesthetic for the block procedure. Here we compare the efficacy of peribulbar block in cataract surgery using the combination of 1:1 mixture of 2% lidocaine with 0.5% bupivacaine and 1:1 mixture of 2% lidocaine with 0.75% ropivacaine. Materials and Methods: It is a prospective, randomized, double blinded study including 60 patients were devided into two groups of 30 each, Group-R received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0.75% ropivacaine and 15 IU/ml of hyaluronidase and group-B received 8 ml of 1:1 mixture of 4 ml of 2% lidocaine, 4 ml of 0. 5% bubivacaineand 15 IU/ml of hyaluronidase. Peribulbar block was performed as per Bloomberg's modification of the Davis and Mandel technique where 5 ml of local anesthetic was injected in the infero temporal region and 3 ml of drug was injected in the superi nasal area. Patients were assessed for sensory block, eyelid and occular movements at an interval of 2 minutes. Systolic, diastolic and mean arterial pressures, heart rate, oxygen saturation, ECG were monitored non invasively at 1,3,5,8,10,15 and then every 10 minutes till the end of the surgery. Observation and Discussion: Mean time for the onset of sensory blockade was 2.70 ± 6.5 minutes in Group B and 2.63 ± 0.57 minutes in group R with P-value 0.671, showing no significant difference in the onset of sensory blockade. Onset of motor blockade was 6.53 ± 1.81 minutes in group B, and 7.57 ± 1.46 minutes in the group R, the P-value being 0.018 was statistically significant. Regarding the duration of analgesia, our study showed mean time for analgesia lasted for 295 ± 54.63 minutes in group B and 414.67 ± 99.47 in group R with P value 0.001 showing statistically significant prolongation of duration of analgesia with group R. We observed a significant increase of mean IOP in bupivacaine group from 13.333 ± 1.582 mm Hg to 21.966 ± 2.697 mm Hg, whereas in ropivacaine group it increased from 12.766 ± 1.222 mm Hg to 13.0 ± 1.341 mm Hg after peribulbar anaesthesia. [ABSTRACT FROM AUTHOR]

Background: Ophthalmic surgery is a common procedure in pediatric populations, and anesthesia is used to ensure patient comfort and safety during the surgery. The aim of this study was to compare the efficacy and safety of topical anesthesia and peribulbar block as an adjuvant to general anesthesia in children undergoing ophthalmic surgery. Objectives: The study aimed to evaluate the differences in hemodynamic changes during surgery, pain relief during and after surgery, and the duration of postoperative pain relief between the two anesthesia techniques. It also aimed to examine the occurrence of ocular-cardiac reflex and changes in intraocular pressure. Methodology: A randomized control study was conducted with two groups, Group GA-PB, consisting of general anesthesia with peribulbar block, and Group GA-TA, consisting of general anesthesia with topical anesthesia. The study population consisted of 50 children aged 2 to 12 years. The primary outcome measures included differences in intraoperative hemodynamic changes, the need for pain relief during and after surgery, and the duration of postoperative pain relief. The secondary outcome measures included the occurrence of ocular-cardiac reflex, incidence of postoperative nausea and vomiting, and changes in intraocular pressure. Results: There was no significant difference in age and weight between the two groups. The mean preoperative and intraoperative intraocular pressure did not differ significantly between the two groups. The GA-PB group showed significantly lower heart rate during surgery and required less pain relief during and after surgery. The duration of postoperative pain relief was also longer in the GA-PB group. There were no significant differences in oxygen saturation, blood pressure, incidence of ocular-cardiac reflex, or changes in intraocular pressure between the two groups. Conclusion: The study concluded that peribulbar block as an adjuvant to general anesthesia was more effective in reducing pain during and after ophthalmic surgery in children. It also showed that peribulbar block did not have any adverse effects on hemodynamic changes, oxygen saturation, or intraocular pressure. Therefore, peribulbar block can be considered as a safe and effective option for anesthesia in pediatric ophthalmic surgeries. [ABSTRACT FROM AUTHOR]

Background: In squint and buckle surgeries, the intraoperative pain of muscle traction might not be completely prevented by local anesthetic (LA) drugs. Adding fentanyl to LA can avoid systemic opioids side effects. Objectives: The aim of the current work was to evaluate the safety and efficacy of adding fentanyl to peribulbar block to abolish or decrease muscle traction pain during squint or buckle operations. Patients and methods: This randomized clinical trial study included a total of 60 adult patients (18-65-year-old) of both genders booked for either squint or scleral buckle surgeries, attending at Research Institute of Ophthalmology, Giza, Egypt. Patients were allocated randomly into two groups (30 patients each); fentanyl group and control group. Intraoperative pain was the primary outcome, whereas secondary outcomes included the onset of complete akinesia and patient satisfaction. Results: The median pain score was 1 for both groups. Two patients of the fentanyl group and 5 patients of the control group required general anesthesia. The mean time to achieving complete akinesia was shorter in the fentanyl group with a significant statistical difference (134.2±35.8 vs. 156.3±34.7, p = 0.018). The patient satisfaction was more with fentanyl use but with no statistical significance. Conclusions: It could be concluded that fentanyl added to the local anesthesia mixture of peribulbar block in squint and scleral buckle surgeries shorten the time needed to achieve complete akinesia. However, it does not improve the intraoperative pain resulting from muscle traction. Also, it does not affect the need for general anesthesia or postoperative patient satisfaction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Peribulbar block (PBB), under which the majority of ocular surgeries are performed, is associated with several complications like conjunctival chemosis, hemorrhage, lid edema, retrobulbar hemorrhage, myotoxicity, and optic nerve injury. The volume of drug injected is 6-10 mL. Thus, a new innovative technique of peribulbar block through the medial canthus (MCB) with a lesser volume of 5 mL was developed as an alternative to conventional peribulbar block. The aim of the study was to assess effectiveness, safety profile, complications, and severity of pain in MCB for intraocular surgeries and to compare the same with conventional PBB. MATERIAL AND METHODS: A total of 54 patients and 108 eyes planned for cataract surgery -- phacoemulsification and small incision cataract surgery (SICS) -- were enrolled for the study. One eye of each patient was operated on under PBB anaesthesia, and the other eye under MCB. Anaesthesia, akinesia, complications, and pain associated with both block techniques were assessed and compared. RESULT: MCB allowed to achieve higher akinesia (overall akinesia score was low), better block-induced anaesthesia(no sensation), lesser pain sensation during the block (numerical pain scale), and fewer complications than conventional PBB. CONCLUSION: MCB is superior to conventional PBB in terms of efficacy, safety profile, complications, and associated pain. A smaller quantity of drugs required is an added advantage. [ABSTRACT FROM AUTHOR]

This study aimed to assess the safety and efficacy of a neostigmine/ketorolac combination as an adjuvant to a low-dose local anesthetic mixture used for peribulbar block during vitrectomy surgeries. This double-blinded, parallel-group, randomized trial enrolled 50 adult patients of both genders who were American Society of Anesthesiologists physical status I or II and were scheduled for vitrectomy surgeries under regional anesthesia. All patients underwent peribulbar block through a single medial canthus injection technique. In the neostigmine and ketorolac (NK) group, 25 patients received a combined mixture of neostigmine (300 μg) and ketorolac (4 mg/ml) as adjuvants to a mixture of lidocaine (2%, 2.5 ml) and bupivacaine (0.5%, 3.5 ml) containing 75 units of hyaluronidase. The control (C) group received 1.5 ml of normal saline instead of neostigmine/ketorolac. The primary outcomes were the onsets and durations of both sensory and motor blocks. Secondary outcomes included the time to first analgesic dose, hemodynamics, adverse effects, and patient's and surgeon's satisfaction. The onsets of sensory and motor blocks were significantly shorter in the NK group compared to the C group. A significantly longer anesthesia and akinesia duration were observed in the NK group in comparison to the C group. The meantime to the first analgesic dose showed a significant difference between the NK and C groups. The NK group had a higher rate of adverse effects than the C group, though not reaching statistical significance. Patients' and surgeons' satisfactions were significantly higher in the NK group than the C group. In peribulbar anesthesia for vitrectomy surgery, adding neostigmine/ketorolac combination to a low-dose local anesthetic mixture was effective in reducing the onset and prolonging the duration of both sensory and motor block, and it was associated with higher safety and better patients' and surgeons' satisfaction. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate safety and efficacy of magnesium sulphate as an adjuvant to peribulbar block at two different doses (75 and 100 mg) in reducing intraocular pressure (IOP) in obese patients undergoing glaucoma surgery. Forty-six adult patients, American Society of Anesthesiologists status I–III, with body mass index of 30–55 kg/m2 undergoing glaucoma surgery under peribulbar block were enrolled during February, 2021. Patients were randomly assigned into two groups (1:1). Both groups received 4 ml of lidocaine 2%, 4 ml of bupivacaine 0.5%, and 1 ml of hyaluronidase (10IU of hyaluronidase/ml of lidocaine). Magnesium sulphate was added to this mixture either in a dose of 75 mg (group I) or 100 mg (group II). Primary outcomes included onset of globe and lid akinesia and IOP. Secondary outcomes included durations of analgesia and motor block, patients' and surgeons' satisfaction, and vital data. The mean onsets to globe and lid akinesia were significantly lower in group II compared to group I (2.7 vs. 4.2 min, p < 0.001 and 3.1 vs. 4.2 min, p = 0.001, respectively). After the block, the mean IOP was significantly lower in group II at 1 min (27.2 vs. 32.7 mmHg, p = 0.0034), 3 min (26.5 vs. 32.4 mmHg, p = 0.002) and 5 min (26.2 vs. 32.1 mmHg, p = 0.001). Group II had a significantly longer mean durations of analgesia (3.5 vs. 2 hours, p < 0.001) and recovery of motor block than group I (3.3 vs. 2.3 hours, p < 0.001). No complications were encountered during the surgery. Magnesium sulphate at a dose of 100 mg demonstrated higher efficacy while maintaining safety compared to the dose of 75 mg. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of sub-tenon block to peribulbar block with respect to analgesia, akinesia, and complications.Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small-incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant.Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub-tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups.Conclusion: Sub-tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS. [ABSTRACT FROM AUTHOR]

Background: Dexmedetomidine has not been adequately studied as an adjuvant to peribulbar anesthesia in strabismus surgery., Objectives: We investigated how different routes of dexmedetomidine administration affect the peribulbar block characteristics in adults undergoing strabismus surgery., Study Design: A randomized, double-blind clinical trial. The study was approved by the Institutional Ethics Committee (approval number: 520/3/2021) and registered at ClinicalTrials.gov (NCT05215158)., Setting: The trial included 46 patients aged 20-60 years with an American Society of Anesthesiologists Physical Status Classification System of  I or II who were scheduled for unilateral strabismus surgery at a university hospital., Methods: Patients were randomly assigned to an intravenous dexmedetomidine group (n = 15) who received 50 µg dexmedetomidine in 50 mL normal saline intravenously over 10 minutes, followed by a peribulbar block using a 10 mL mixture of 4 mL lidocaine 2%, 4 mL bupivacaine 0.5%, and 2 mL normal saline containing 150 international units (IU) hyaluronidase. The peribulbar dexmedetomidine group (n = 31) received 50 mL normal saline intravenously over 10 minutes, followed by a peribulbar block using a 10 mL mixture of 4 mL lidocaine 2%, 4 mL bupivacaine 0.5%, 1 mL normal saline with 150 IU hyaluronidase, and 1 mL normal saline containing 50 µg dexmedetomidine. Sensory and motor block onset and duration, analgesia duration, and patient and surgeon satisfaction were evaluated., Results: Peribulbar dexmedetomidine prolonged the median duration of postoperative analgesia by 3.2 hours. Patients who received peribulbar dexmedetomidine benefitted from a longer time to request postoperative analgesia than those who got intravenous dexmedetomidine (7.17 ± 2.0 hours vs 5.79 ± 2.1 hours; P = 0.048). Motor block duration was longer in the peribulbar group compared to the intravenous group (198.34 ± 17.3 minutes vs 148.93 ± 13.7 minutes; P = 0.001). Patient and surgeon satisfaction was higher in the peribulbar dexmedetomidine group compared to the intravenous dexmedetomidine group (P = 0.048, P = 0.016, respectively). Strabismus surgery duration was shorter in the intravenous dexmedetomidine group than in the peribulbar group (38.01 ± 8.3 minutes vs 55.01 ± 11.9 minutes; P < 0.001)., Limitations: Our study took place at a single-center with a small sample size limited to adult patients undergoing strabismus surgery. The study was not powered to identify differences in speed of sensory block onset and duration, or speed of motor block onset. However, peribulbar dexmedetomidine prolonged the motor block's duration., Conclusion: Peribulbar dexmedetomidine outperforms intravenous dexmedetomidine in terms of postoperative analgesia and motor block duration when used as an adjunct to peribulbar anesthesia for strabismus surgery. However, the intravenous group had significantly shorter surgical times.

Purpose: To compare the efficacy and safety of sub-tenon block to peribulbar block with respect to analgesia, akinesia, and complications. Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small-incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant. Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub-tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups. Conclusion: Sub-tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS.

Background and Aims: Peribulbar anesthesia is suitable for vitreoretinal (VR) surgery. Dexmedetomidine has been used in peribulbar block (PBB) to improve akinesia and analgesia. We aimed to study the efficacy of adding dexmedetomidine to 0.75% Ropivacaine in PBB for VR surgery. The primary outcome was the requirement of block supplementation and secondary outcome was post-operative analgesic requirement. Material and Methods: 100 adult patients undergoing VR surgery were included in this prospective randomized double-blinded controlled study. The composition of the drug used for PBB in the 3 groups was Group R (8 ml of 0.75% Ropivacaine +0.5 ml normal saline (NS)), Group D25 (8 ml of 0.75% Ropivacaine +25μg Dexmedetomidine) and Group D50 (8 ml of 0.75% Ropivacaine +50 μg Dexmedetomidine). Results: The groups were comparable in terms of patient demographics. The requirement for block supplementation was 16.7% in Group R (5/30), 12.5% in Group D25 (4/32) and 8.8% in group D50 (3/34) (P = 0.64).The mean time to first request for post-operative analgesia was432 ± 362 min in Group R, 572 ± 339 min in Group D25 and 614 ± 394 min for Group D50 (P = 0.26). There was significant difference in the heart rate (P = 0.047), mean arterial pressure (P = 0.012) at 30 min and sedation (RASS) score at 15, 30, 60 (P < 0.001) and 120 (P = 0.019) min between the D50 and group R. Patients undergoing buckling procedures had significantly shorter time to request for analgesia (P = 0.003). Conclusion: Addition of dexmedetomidine does not offer advantage over 0.75% Ropivacaine in PBB for vitrectomy. Its benefit in more painful procedures like scleral buckle needs further validation.

Abstract Background The aim of the study was to evaluate the impact of addition of dexmedetomidine or magnesium sulphate to the standard local anesthetics mixture as a primary objective and to compare between both as a secondary objective utilizing the single-injection percutaneous technique for peribulbar block. In this prospective randomized double-blinded clinical trial (RCT), sixty patients, both sexes, aged 45 to 75, with an ASA of I to III, were scheduled for cataract extraction operation. They were divided into three equal groups; each received a single injection peribulbar block of a mixture of 0.5% bupivacaine (3 ml) + 2 percent lidocaine (3 ml) + 120 IU hyaluronidase + (control group (C): 0.5 ml of normal saline; group D: 50 μg of dexmedetomidine; group M: 50 mg of magnesium sulphate in 0.5 ml) with a total injected volume of 7 ml each. The duration of sensory, motor block, need for supplementary doses, hemodynamics, and satisfaction of patients and surgeons were assessed. Results For the primary outcome, both the dexmedetomidine and magnesium groups revealed statistically significant differences from the control group with shorter onsets of sensory block and lid akinesia (p value< 0.001 for both), shorter onset of globe akinesia for dexmedetomidine (p value

Background: Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, it has the disadvantages of a slower onset of orbital akinesia and the frequent requirement for block supplementation. Aim of the Work: To evaluate the effect of addition of magnesium sulfate and rocuronium to standard local anesthetics mixture on the time of onset of globe and lid akinesia and corneal anesthesia for peribulbar block in ophthalmic surgeries. Patients and Methods: This Prospective Double-blinded Randomized Study was carried out in the ophthalmic surgery unit, Ain Shams university hospital from January 2019 to April 2020. After institutional Ethical Board approval and obtaining written informed patients' consents, 75 patients from both sexes, ASA physical status I-III, aged 40-80 years and having an Axial globe length less than or equals 26 mm scheduled for cataract surgery under peribulbar block were included in the study. Results: Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00±1.22) than control group and magnesium sulfate group (9.00±1.47 and 9.00±1.15) respectively, (p < 0.001); Moreover, no statistically significant difference was reported between control group and magnesium sulfate group. In addition, no significant difference was reported regarding duration of surgery between groups Conclusion: Adding Rocuronium to local anesthetic mixture in peribulbar block during cataract surgery enhances ocular akinesia and corneal anesthesia and reduces the need for supplementary injections with no side effects and that was significantly better than Magnesium sulfate in term of rapid onset and time needed to achieve adequate condition to begin surgery. However, adding Magnesium sulfate showing good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery. [ABSTRACT FROM AUTHOR]

Introduction Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications. Aim To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery. Patients and methods The study included 40 adult patients (ASA II-IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 µg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded. Results The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D. Conclusion Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement. [ABSTRACT FROM AUTHOR]

Background and Aims: Peribulbar anesthesia is suitable for vitreoretinal (VR) surgery. Dexmedetomidine has been used in peribulbar block (PBB) to improve akinesia and analgesia. We aimed to study the efficacy of adding dexmedetomidine to 0.75% Ropivacaine in PBB for VR surgery. The primary outcome was the requirement of block supplementation and secondary outcome was post-operative analgesic requirement. Material and Methods: 100 adult patients undergoing VR surgery were included in this prospective randomized double-blinded controlled study. The composition of the drug used for PBB in the 3 groups was Group R (8 ml of 0.75% Ropivacaine +0.5 ml normal saline (NS)), Group D25 (8 ml of 0.75% Ropivacaine +25μg Dexmedetomidine) and Group D50 (8 ml of 0.75% Ropivacaine +50 μg Dexmedetomidine). Results: The groups were comparable in terms of patient demographics. The requirement for block supplementation was 16.7% in Group R (5/30), 12.5% in Group D25 (4/32) and 8.8% in group D50 (3/34) (P = 0.64).The mean time to first request for post-operative analgesia was432 ± 362 min in Group R, 572 ± 339 min in Group D25 and 614 ± 394 min for Group D50 (P = 0.26). There was significant difference in the heart rate (P = 0.047), mean arterial pressure (P = 0.012) at 30 min and sedation (RASS) score at 15, 30, 60 (P < 0.001) and 120 (P = 0.019) min between the D50 and group R. Patients undergoing buckling procedures had significantly shorter time to request for analgesia (P = 0.003). Conclusion: Addition of dexmedetomidine does not offer advantage over 0.75% Ropivacaine in PBB for vitrectomy. Its benefit in more painful procedures like scleral buckle needs further validation. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground: This study aimed to evaluate safety and efficacy of adding two different doses of neostigmine to the local anesthetic lidocaine in peribulbar block anesthesia for cataract surgery.Methods: This randomized, double blind, parallel group, controlled trial (Trial registration number: IRCT20210106049952N1) included 60 patients (30–70 years-old), ASA physical status I, II, or III who were scheduled for cataract surgery. Patients received standard peribulbar block (Group C) or standard block plus 0.25 mg neostigmine (Group N25) or 0.5 mg neostigmine (Group N50). All patients were assessed for primary outcomes including hemodynamics and onsets of motor and sensory blocks. Secondary outcomes included duration of block, patient’s and surgeon’s satisfaction, postoperative pain, and time to first analgesic dose.Results: Mean onset of motor block was significantly shorter in N25 and N50 groups (72.25 ± 20.3 and 44.3 ± 10.4 sec, respectively) than in control group (110.25 ± 35.6 sec). Onset of sensory block was significantly shorter in N50 group compared to control group as well as N25 group (P

Purpose: The purpose of this study is to assess the effect of dexmedetomidine on intraocular pressure (IOP) as an additive in peribulbar injections in glaucoma surgeries. Methods: A prospective, randomized, double-blind, parallel assignment interventional study was conducted for patients undergoing glaucoma surgeries at a tertiary eye care hospital in North India. Patients were randomized to two groups, Dexmed group and Placebo group. In the Dexmed group, dexmedetomidine (0.4 μg/kg body weight) was given as an additive along with peribulbar block. The primary outcome was change in IOP pre- and postperibulbar injections (IOP before the block, and after 5 and 15 min of the block). Secondary outcome measures were onset of block, adverse effects (bradycardia, hypotension, respiratory depression, and level 4 sedation), and surgeon satisfaction. Results: A total of 104 patients were randomized, 52 each in the Dexmed group and Placebo group. The percentage decrease in IOP was significantly more in the Dexmed group than in the Placebo group both at 5 and 15 min' post block (P < 0.05). At 5 min, the mean percent decrease in IOP in Dexmed group was -10.48, whereas it was 2.85 in the Placebo group. At 15 min, the mean percent decrease in IOP was -22.59 and -9.42 in the Dexmed and Placebo group, respectively. There was no significant difference between the two groups in the onset of block and adverse effects. Surgeon satisfaction was significantly greater in the Dexmed group than the Placebo group (P < 0.05). Conclusion: Dexmedetomidine lowers IOP significantly in patients undergoing glaucoma surgeries with safe hemodynamic changes and sedative effect.

Purpose: Enucleation performed in children with retinoblastoma is associated with severe postoperative pain. The use of opioids for the pain is associated with numerous complications which demand careful monitoring. Subtenon infiltration and peribulbar block are useful in ameliorating pain perioperatively following various ophthalmic surgeries which are yet to be evaluated in enucleation. Therefore, we designed this study to compare the effects of peribulbar block and subtenon infiltration on postoperative pain with opioids in pediatric enucleation surgeries. Methods: 60 children of American Society of Anesthesiologists grade I and II, age ranging from 6 months to 6 years with retinoblastoma undergoing enucleation surgery were included in the study. Group A (n = 20): received peribulbar block (peribulbar group); Group B (n = 20): received subtenon local infiltration (subtenon group); and Group C (n = 20): no block was given. Results: The postoperative fentanyl consumption was lowest with Group B compared to Group A and Group C (P value 0.001). However, the total fentanyl consumption was comparable between groups A and B, while it was significantly higher in the control group. The mean pain score face, legs, activity, cry, consolability (FLACC) scale and mean time to discharge from post anesthesia care unit were lowest in Group B followed by Group A, while Group C had the highest. There was no statistically significant difference among the 3 groups with regards to side effects. Conclusion: Subtenon infiltration showed significantly better outcomes when compared to peribulbar block and intravenous opioids alone without any untoward adverse effects.

Background: The addition of adjuvants to local anesthetics in the peribulbar block might be a method to elevate block quality. This study aimed to determine the effectiveness of peribulbar local anesthesia adjuvants using dexmedetomidine 20 mcg and dexamethasone 5 mg. Patients and Methods: This study was a single-blind randomized clinical trial. Patients were divided into three groups who received peribulbar group: Group C (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of normal saline), Group D (4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexamethasone 5 mg), and Group M (received 4 ml of levobupivacaine 0.5% and 4 ml of 2% lidocaine added with 1 ml of dexmedetomidine 20 mcg). Sensory and motor block onsets and durations were assessed. Results: There were 42 patients included. The sensory block onset was 70.7 s in Group M and the slowest in Group C (152.1 s). The longest sensory block duration was found in Group D (259.3 min) and the shortest in Group C (143.2 min). Conclusion: Dexamethasone 5 mg adjuvant affected sensory block onset, sensory, and motor block duration but did not affect motor block onset, while dexmedetomidine 20 mcg adjuvant affected sensory and motor block onsets as well as sensory and motor block durations.

Aim: This study aims to assess the various ocular and systemic complications of peribulbar block in supine posture among patients undergoing cataract surgery in a tertiary care center in Chennai. Materials and Methods: A retrospective analysis of complications that occurred in 880 patients who had been given peribulbar block in supine posture, during 36 months between January 2016 and January 2019 among patients who underwent cataract surgery at a tertiary care hospital. Patients with uncontrolled diabetes mellitus, hypertension, bronchial asthma, and cardiac illness were excluded from the study. The other exclusion criteria were pediatric age group and trauma. The data thus collected from the records were entered and analyzed using descriptive analysis. Results: Out of 880 patients operated in a 36-month period at Government Medical College Hospital who received peribulbar block in the supine posture, 42 (4.77%) patients had block-related systemic complications; bradycardia and vasovagal attack-40 (4.54%) patients; brainstem anesthesia and syncope-2 (0.22%). The incidence of orbital complications was 82 (9.31%). Out of the orbital complications, the most common complication was periorbital hematoma occurred in 50 (5.68%), followed by retrobulbar hemorrhage occurred in 32 (3.63%). Conclusion: The observation-based conclusion is various ocular and systemic complications can occur in peribulbar block. Hence, the operation theatre should be equipped with appropriate instruments and trained personnel to deal with all kinds of emergencies.

Background: This study aimed to evaluate safety and efficacy of adding two different doses of neostigmine to the local anesthetic lidocaine in peribulbar block anesthesia for cataract surgery. Methods: This randomized, double blind, parallel group, controlled trial (Trial registration number: IRCT20210106049952N1) included 60 patients (30–70 years-old), ASA physical status I, II, or III who were scheduled for cataract surgery. Patients received standard peribulbar block (Group C) or standard block plus 0.25 mg neostigmine (Group N25) or 0.5 mg neostigmine (Group N50). All patients were assessed for primary outcomes including hemodynamics and onsets of motor and sensory blocks. Secondary outcomes included duration of block, patient's and surgeon's satisfaction, postoperative pain, and time to first analgesic dose. Results: Mean onset of motor block was significantly shorter in N25 and N50 groups (72.25 ± 20.3 and 44.3 ± 10.4 sec, respectively) than in control group (110.25 ± 35.6 sec). Onset of sensory block was significantly shorter in N50 group compared to control group as well as N25 group (P < 0.001). A significantly longer mean duration of block was observed in N50 group (173.55 ± 31.09 min) in comparison to control group (79.75 ± 12.51 min) and N25 group (81.25 ± 6.25 min). Mean time till first analgesic dose showed significant differences between the three groups C, N25, and N50 (2.85 ± 0.47, 3.45 ± 1.28, and 7.1 ± 1.25 h, respectively, P < 0.001). Only two patients belonging to N50 group developed postoperative nausea and vomiting. Conclusion: Neostigmine in 0.5 mg was superior to 0.25 mg dose when added to the local anesthetic lidocaine in peribulbar anesthesia for cataract surgery regarding both sensory and motor block as well as postoperative analgesia. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to evaluate the impact of addition of dexmedetomidine or magnesium sulphate to the standard local anesthetics mixture as a primary objective and to compare between both as a secondary objective utilizing the single-injection percutaneous technique for peribulbar block. In this prospective randomized double-blinded clinical trial (RCT), sixty patients, both sexes, aged 45 to 75, with an ASA of I to III, were scheduled for cataract extraction operation. They were divided into three equal groups; each received a single injection peribulbar block of a mixture of 0.5% bupivacaine (3 ml) + 2 percent lidocaine (3 ml) + 120 IU hyaluronidase + (control group (C): 0.5 ml of normal saline; group D: 50 μg of dexmedetomidine; group M: 50 mg of magnesium sulphate in 0.5 ml) with a total injected volume of 7 ml each. The duration of sensory, motor block, need for supplementary doses, hemodynamics, and satisfaction of patients and surgeons were assessed. Results: For the primary outcome, both the dexmedetomidine and magnesium groups revealed statistically significant differences from the control group with shorter onsets of sensory block and lid akinesia (p value< 0.001 for both), shorter onset of globe akinesia for dexmedetomidine (p value<0.001) and for magnesium sulphate (p value=0.022), prolonged duration of lid and globe akinesia and sensory block (p value<0.001), better patient satisfaction (p value=0.044) but insignificant difference regarding surgeons' satisfaction (p value= 0.117) and a less frequent, but statistically insignificant need for supplementary injection (p value=0.075). The demographic and clinical hemodynamics and oxygen saturation parameters were comparable between the three groups. For the secondary outcome, dexmedetomidine was superior to magnesium sulphate regarding onset of globe and lid akinesia (p value= 0.047 and 0.003, respectively), and durations of globe akinesia and sensory block (p value= 0.02 and 0.016, respectively). No complications related to the drugs or procedure were recorded. Conclusions: When compared to 50 mg magnesium sulphate, dexmedetomidine at a dose of 50 μg is a superior adjunct to local anesthetic combination in peribulbar block for cataract procedures in terms of start and duration of peribulbar block. [ABSTRACT FROM AUTHOR]

Purpose: Enucleation performed in children with retinoblastoma is associated with severe postoperative pain. The use of opioids for the pain is associated with numerous complications which demand careful monitoring. Subtenon infiltration and peribulbar block are useful in ameliorating pain perioperatively following various ophthalmic surgeries which are yet to be evaluated in enucleation. Therefore, we designed this study to compare the effects of peribulbar block and subtenon infiltration on postoperative pain with opioids in pediatric enucleation surgeries.Methods: 60 children of American Society of Anesthesiologists grade I and II, age ranging from 6 months to 6 years with retinoblastoma undergoing enucleation surgery were included in the study. Group A (n = 20): received peribulbar block (peribulbar group); Group B (n = 20): received subtenon local infiltration (subtenon group); and Group C (n = 20): no block was given.Results: The postoperative fentanyl consumption was lowest with Group B compared to Group A and Group C (P value 0.001). However, the total fentanyl consumption was comparable between groups A and B, while it was significantly higher in the control group. The mean pain score face, legs, activity, cry, consolability (FLACC) scale and mean time to discharge from post anesthesia care unit were lowest in Group B followed by Group A, while Group C had the highest. There was no statistically significant difference among the 3 groups with regards to side effects.Conclusion: Subtenon infiltration showed significantly better outcomes when compared to peribulbar block and intravenous opioids alone without any untoward adverse effects. [ABSTRACT FROM AUTHOR]